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Medical Emergencies > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

What details should be recorded on someone’s faint/collapse episode?

A
  1. ) Circumstances of event
  2. ) Posture just before loss of consciousness
  3. ) Prodromal symptoms (sweat/warmth)
  4. ) Presence or absence of movement during event
  5. ) Tongue biting?
  6. ) If injury occurred during event
  7. ) Duration
  8. ) Copies of the ECG and patient report form given on transfer of pt.
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2
Q

What 3 things can cause faints/collapse

A
  1. ) NEUROGENIC SYNCOPE
  2. ) CARDIOGENIC SYNCOPE
  3. ) NEUROCARDIOGENIC SYNCOPE ‘SIMPLE FAINT’

SYNCOPE = FALL IN BLOOD PRESSURE

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3
Q

What are the features of a Neurogenic Syncope (brain)

A
  • Also known as a vasovagal syncope - natural mechanism of falling so blood goes back to the brain
  • Occurs when body overreacts to triggers like intense emotion/sight of blood/heat/dehydration
  • History of neurogenic problems: Epilepsy
  • Loss of sphincter tone (urination)
  • Tongue biting
  • Prodrome (pre-expectancy)
  • Clinical features
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4
Q

What is the difference between a faint and a collapse

A

Collapse - sudden loss of postural tone

Faint - transient loss of consciousness

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5
Q

What may be the cause of Neurogenic syncope

A
  • Seizure / Epilepsy
  • Sub-arachnoid haemorrhage
  • Not stroke
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6
Q

What is a Cariogenic syncope (heart) and what may cause it

A

• Arrhythmias:

  • Bradycardia
  • Tachycardia

• Valvular pathology:

  • Aortic stenosis
  • Mitral stenosis
  • Structural heart disease: Hypertrophic Cardiomyopathy (HCM)
  • Pulmonary embolus
  • Primary Electrophysiological Abnormalities
  • Brugada syndrome
  • Long QT syndrome
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7
Q

How diagnose a syncope as a Vasovagal one (Neurocardiogenic)

A
  • Commonest type of faint
  • 3 P’s - Posture, Provoking, Prodrome
  • Transient LOC
  • Rapid recovery, often ongoing headache, mild nausea
  • Overstimulation of vagus nerve +/- sympathetic tone loss
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8
Q

Name the NICE Red Flag Signs with a syncope (leading to the belief that it is not vasovagal)

A

Refer within 24 hours for specialist IF:

  • ECG abnormality
  • Heart failure (history or clinical signs)
  • TLoC during exertion
  • Family history of sudden cardiac death in people aged 40 years
  • Heart murmur
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9
Q

How do we treat faints

A

• Assess the Airway, Breathing, Circulation (ABC)
- Lay flat, elevate legs, recovery position if necessary

• If occurs after unpleasant stimulus (LA injection) and recovery rapid

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10
Q

What is Hypoglycaemia

A
  • Lower than normal blood sugar

* Normal ranges 4 - 7

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11
Q

What are the features of Hypoglycaemia

A
  • Hunger
  • Irritability
  • Headache
  • Altered/reduced LOC
  • Difficulty speaking
  • Ataxia dyscoordination (drunkenness)
  • Seizures
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12
Q

What are the causes of Hypoglycaemia

A
  • Too little fuel
  • Too much insulin
  • Excess oral diabetic drugs
  • Alcohol induced hypoglycaemia
  • Sepsis
  • Insulin-secreting pancreatic tumour
  • Adrenal insufficiency / Hypopituitarism
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13
Q

How do we treat Hypoglycaemia

A
  • SUGAR
  • Carbohydrate if symptoms minimal (Jelly babies)
  • Increasing symptoms use oral gel
  • IV if significant symptoms (seizures - can’t swallow)
  • Hospital assessment focused on treatment and identifying cause
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14
Q

What is Anaphylaxis

A
  • Extreme allergy
  • IgE mediated (anaphylactoid reactions clinically similar but not IgE mediated)
  • Caused by reaction to allergen (food / drugs / NSAIDs)
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15
Q

Describe the pathophysiology of Anaphylaxis

A
  • Antigen binds to IgE antibodies on mast cells based in connective tissue throughout the body
  • Degranulation of mast cells with release of inflammatory mediators
  • Inflammatory mediators cause common symptoms of allergic reactions, such as itching rash and swelling
  • Can also cause bronchial constriction, vasodilation
  • Anaphylactic shock is an allergic reaction with respiratory symptoms and circulatory collapse - can be fatal if untreated in time
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16
Q

What are the clinical features of Anaphylaxis

A

•Respiratory distress:

  • Stridor
  • Tachypnoea
  • Wheeze
  • Cyanosis

• Circulatory signs:

  • Pallor
  • Cool peripheries
  • Tachycardia
  • Hypotension

• CNS:

  • Anxiety
  • Agitation
  • Reduced LOC

GI:

  • Abdominal pain
  • D&V

SKIN:
- Urticaria

17
Q

What does the Resuscitation guidelines say for an anaphylactic shock

A

1.) ABC

  1. ) - Call for help
    • Lie pt. flat
    • Raise pt. legs

3.) GIVE ADRENALINE 500mg

4.)
• Establish airway

  • High flow oxygen
  • Chlorphenamine
  • Hydrocortisone
  • Nebulised B agonist (salbutamol)
18
Q

What is the treatment course if this happened in your practice

A
  • Remove/Stop cause
  • Assess A B C
  • Intramuscular adrenaline 500mg
  • Oxygen
  • Nebulised B agonist (salbutamol)
  • 999 to ED
19
Q

What is Asthma

A
  • Increased airway activity
  • Atopic/non-atopic
  • Various triggers
  • Acute attacks - wheezing, SOB, ‘tight chest’, cough
20
Q

How do we treat an Asthma Attack

A
  • Try and prevent allergen
  • Inhaled B-agonists - salbutamol, terbutaline (ventolin)
  • Steroids if indicated to reduce airway inflammation - does not cause immediate relief in asthma attack
  • Others - Magnesium, IV aminophylline, venitlation
21
Q

How does Ischamemic Heart disease happen? What is the process?

A
  • Coronary arteries around heart supplies it with O2 etc..
  • High cholesterol and high blood pressure with turbulence can erode some of the lining of the blood vessel away.
  • This exposes the tissue underneath and so a fatty streak is formed to reduce the blood flow around it. This narrows the vessel.
  • This narrowing causes the protective layer to become necrotic plaque
  • This plaque can rupture with flow of blood and exposes the vessel underneath leading to a clot - blockage of arteries - chest pain symptoms etc..
22
Q

What are the 3 types of Ischaemic Heart Disease

A

• STABLE ANGINA:
- Pain on exercie, relieved by rest +/- GTN

• UNSTABLE ANGINA:
- Worsening pain esp at rest, increasing frequency of episodes

• MYOCARDIAL INFARCTION:
- Syptoms, ECG changes, biochemical markers (troponin) 10/10 pain.

23
Q

What are the symptoms of someone with Angina / MI

A
  • Chest pain +/- radiation
  • Nausea/Vomiting
  • Collapse
  • Sweating
  • Pallor
  • Anxiety
24
Q

How do we treat Angina/MI

A
  • ABCDE
  • GTN spray (nitrates)
  • Aspirin (300mg) chew
  • Oxygen (if indicated <94% SpO2)
  • 999 to ED

•Primary PCI for AMI that meet criteria
STEMI more serious needs immediate treatment

• MONA:

  • M = Morphine
  • O = Oxygen
  • N = Nitrates
  • A = Aspirin
25
Q

What is Adrenal Insufficiency

A
  • Inadequate production of steroid hormones
  • Primarily cortisol
  • May have impaired aldosterone production
  • Several causes
26
Q

Causes of Primary Adrenal Insufficiency (impairment of adrenal glands)

A
  • Idiopathic
  • Autoimmune - ADDISON’S DISEASE
  • Congenital adrenal hyperplasia
  • Adenoma (tumour) of the adrenal gland
27
Q

Causes of Secondary Adrenal Insufficiency (impairment of the pituitary gland or hypothalamus)

A
  • Pituitary microadenoma
  • Hypothalamic tumour
  • Sheehan’s syndrome (postpartum pituitary necrosis)
28
Q

What are the causes of Adrenal Insufficiency?

A
  • Weakness, tiredness, dizziness, hypotension
  • Hypoglycemia, dehydration, weight loss, disorientation
  • Myalgia, nausea, vomiting, diarrhoea
  • Hyperkalemia & Hyponatraemia
  • Palmar crease tanning
  • Vitiligo
29
Q

Clinical features of an Adrenal Crisis

A
  • Lethargy, fever
  • Abdominal pain
  • Severe D&V (+/- dehydration)
  • Hypotension
  • Hypoglycaemia
  • Syncope
  • Confusion, psychosis, slurred speech
30
Q

How do we treat Adrenal crisis

A

Give steroid before treatment if you know they have addison’s/pituitary disease

If crisis - 999 if ABCDE fine

31
Q

What is a Seizure

A
  • Not always epileptic
  • Several types
  • Difficult to diagnose
  • Classic seizure dramatic, but rarely problematic
32
Q

Difference between a Partial and a Generalised Seizure

A

Partial - one part of his body - may have LOC (simple / complex)

Generalised - all have LOC (absence, tonic-clonic, myoclonic, tonic, atonic)

33
Q

What are the causes of a Seizure?

A
  • Epilepsy (including drug non-compliance or interactions)
  • Fatigue
  • Intracranial lesion
  • Drug and alcohol intoxication/ withdrawal
  • Intracranial infection - encephalitis or meningitis
  • Metabolic disturbances - hypoglycaemia, hyponatraemia or hypoxia
  • Multiple sclerosis
34
Q

How to manage a Seizure

A
  • Protect patient from injury
  • Most come to no harm at all, post-ictal phase may be distressing and prolonged
  • Classic tonic-clonic seizure rarely more than 1-2 mins
  • If prolonged - assess ABC and call 999

Medical Emergencies (1 decks)

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